paediatric malnutritionn

Question 1

how is an underweight child defined ?

Answer 1

weight for age < -2 SD

Question 2

how is a stunting child defined ?

Answer 2

height for age < -2 SD

Question 3

how is wasting inn a child defined ?

Answer 3

weight for height < -2SD

Question 4

how is an overweight child defined ?

Answer 4

weight for height > +2 SD

Question 5

what is stunting ?

Answer 5

long term nutritional deprivation and results in :
delayed mental development
poor school performance
reduced intellectual capacity

Question 6

what are the different types of protein energy malnutrition ?

Answer 6

severe PEM :
Marasmus
kwashiorkor

Question 7

how can acute severe malnutrition be diagnosed ?

Answer 7

the presence of one or more of :
mid-upper arm circumference < 115 mm
severe wasting ( < -3SD)
oedema of both feet

Question 8

what are the features of marasmus ?

Answer 8

caused by deprivation of energy + protein
weight loss of more than 20%
maintain their hunger despite appearing irritable

Question 9

what are the physical findings found upon examination of a marasmus patient ?

Answer 9

loss os subcutaneous fat 
wrinkled skin and bone prominence 
limbs appear as skin and bone
severe muscle wasting 
severe growth retardation

Question 10

when does marasmus mainly occur ?

Answer 10

in infants under one year of age

Question 11

when does kwashiorkor mainly occur ?

Answer 11

at the time of weaning

Question 12

what is the pathophysiology behind kwashiorkor ?

Answer 12

previously malnourished patient when exposed to the catabolic stress of infection

Question 13

what are the clinical manifestations of kwashiorkor ?

Answer 13

generalized oedema 
skin rash - hyperkeratosis  and desquamation 
distended abdomen and enlarged liver 
angular stomatitis 
flag sign

Question 14

why may the weight of a kwashiorkor patient not be severely reduced ?

Answer 14

because of the severe oedema

Question 15

what are the lab findings in kwashiorkor ?

Answer 15

everything is reduced except sodium

has dilutional hyponatraemia

Question 16

what are the two phases included in the management of PEM ?

Answer 16

stabilisation and rehabilitation

Question 17

when should iron be introduced in the management of PEM ?

Answer 17

in the rehabilitation phase only

Question 18

what is the prophylactic dose of iron to avoid iron deficiency anemia ?

Answer 18

2mg/kg/day

Question 19

what is the treatment dose of iron in iron deficiency anemia ?

Answer 19

6mg/kg/day for 3 months

Question 20

what is the most common cause of microcytic hypochromic anemia ?

Answer 20

iron deficiency anemia

Question 21

what additional supplementations can be added to children suffering from iron deficiency anemia and refuse to eat haem sources of iron ?

Answer 21

include vitamin c to increase absorption of iron

Question 22

what is pica ?

Answer 22

eating things that are not considered food , and may be associated with iron deficiency anemia

Question 23

what is the clinical presentation of vitamin D deficiency ?

Answer 23

bony deformity

symptoms of hypocalcemia : seizures, tetany, apnea, stridor

Question 24

what is the difference between rickets and osteomalacia ?

Answer 24

rickets :failure in mineralization of the growing bone

osteomalacia : failure of mature bone to mineralize

Question 25

what are the organs involved with calcium absorption ?

Answer 25

the intestines and the kidneys

Question 26

what are the different types of rickets ?

Answer 26

vitamin D deficiency - Renal disease | calcium deficiency - chronic liver disease

Question 27

what is the most likely cause of rickets that is due to both vit d and calcium deficiency ?

Answer 27

malabsorption i.e cystic fibrosis

Question 28

what are the physical features associated with rickets ?

Answer 28

``` delayed closure of sutures bowing of the legs frontal bossing dental hypoplasia pigeon chest harrisons sulcus ```

Question 29

how is a diagnosis of rickets made and how is it confirmed ?

Answer 29

``` mainly clinical but confirmed by testing : ALP phosphatase vit D serum levels serum calcium long bone X-ray ```

Question 30

what is the prophylactic dose of vitamin d ?

Answer 30

400-600 IU/day

Question 31

what is the treatment dose of vit d ?

Answer 31

less than a month : 1000 units from 1-6 months : 3000 units above 6 months: 6000 units all for the duration of one month

Question 32

what is the dose for calcium supplementation ?

Answer 32

500 mg/day

Question 33

what is the commonest cause of blindness in children of developing countries ?

Answer 33

vitamin A deficiency

Question 34

what are the clinical signs of vitamin A deficiency ?

Answer 34

``` xeropthalmia night blindness bitot spots dry skin and hair broken fingernails ```

Question 35

what is the dose of supplementation of vitamin A at 12 months ?

Answer 35

with MMR vaccine 100.000 IU

Question 36

what is the dose of vitamin A given at 18 months ?

Answer 36

with the OPV, DPT and MMR | a dose of 200.000 IU

Question 37

``` what is the treatment dose for vitamin A deficiency ? under 3 years 4-8 years 9-13 years 14-18 years all adults ```

Answer 37

``` under 3 years - 600 mcg 4-8 years - 900 mcg 9-13 years - 1700 mcg 14-18 years - 2800 mcg all adults - 3000 mcg ```